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Simplified Solutions from Emdeon
By complying with the rule, providers may realize more revenue due to the reduction in unpaid bills left by fraudulent actions. Providers will also be able to assure patients that they are taking extra precautions to prevent identity theft-a consumer-pleasing strategy whether patients provide financial information via electronic or paper routes.
Why is this important news for hospitals and physicians? If healthcare providers allow patients to defer payments or set up an outside line of credit to help them pay for care, that is considered acting as a creditor under the federal regulation and will require providers to create a reasonable set of rules to identify red flags to prevent identity theft. In addition, each institution's board of directors will be obligated to monitor the new system. This board will also be accountable for making sure the system is reviewed and updated regularly to deal with the changing marketplace and tactics of identity thieves.
Creating these new procedures can create unique and complex situations for providers due to privacy concerns, regulations, and even legislation (such as HIPAA) specific to the handling of patient records, the securing of financial information, and the refusal of care. Therefore, consulting with the appropriate legal, financial, and technical professionals to ensure compliance should be considered. There are also commercially available tools designed to guide providers through this process. These advisors and programs can help create an efficient and effective system that fits the way a facility currently operates. Because every facility is different, and there is a wide range of options for assistance, it is important to closely examine potential partners to make sure you find someone who understands the unique needs of a healthcare business.
There are no criminal penalties for noncompliance with the FTC Red Flags Rule. However, failure to comply could potentially lead to civil monetary penalties that would be costly for any healthcare business. The primary reason that creditors, businesses, and the healthcare industry should participate is simple: it's what customers and patients expect.
The FTC lists the examples below as events that should set off red flags and trigger a more in-depth review under the new guidelines:
The FTC describes these as starting points, and not the end result every Red Flags system should follow.
Once a suspicious event has been brought to your attention, there are a large number of things that can be done to help protect the integrity of a healthcare business and a patients' privacy. Here are a few suggestions from the FTC:
The responsibility for reducing identity theft and fraudulent activity within the healthcare industry lies with each healthcare provider. The more proactive providers are to address the Red Flags Rule, the more prepared they will be on August 1, 2009.
Learn more by visiting the FTC's web site and be sure to consult documented FTC literature: Fighting Fraud with the Red Flags Rule: A How-To Guide for Business.
Emdeon is the leading provider of integrated patient billing and payment solutions that simplify consumer billing and payment processes for hospitals, physicians, and healthcare providers. Through our innovative suite of print and e-commerce solutions, we facilitate provider-patient communications for optimized revenue collection and enhanced patient satisfaction. Contact us today at 877.EMDEON.6 (877.363.3666) or visit us at www.emdeon.com/pbps to find out more.
Publication Date: Wednesday, July 01, 2009
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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